Provider Demographics
NPI:1114151800
Name:PLOCH, LAUREN ECKERT (MD)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:ECKERT
Last Name:PLOCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:ELIZABETH
Other - Last Name:ECKERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2400 BELLEVUE RD
Mailing Address - Street 2:STE 21A
Mailing Address - City:DUBLIN
Mailing Address - State:GA
Mailing Address - Zip Code:31021-2890
Mailing Address - Country:US
Mailing Address - Phone:478-328-0281
Mailing Address - Fax:478-328-0438
Practice Address - Street 1:2283 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30904-4717
Practice Address - Country:US
Practice Address - Phone:706-733-3373
Practice Address - Fax:706-733-3370
Is Sole Proprietor?:No
Enumeration Date:2009-05-08
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204085207N00000X
SC39037207N00000X
LA390200000X
GA075228207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08037090Medicaid
LA1795739Medicaid
LA313628YH3UMedicare PIN